Abstract 102: Use of Emergency Medical Services by Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Aaron M Anderson ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
Opeolu Adeoye ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Time Window ◽  
Action Plan ◽  
Medical Services ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Awareness Campaigns ◽  
Emergency Medical ◽  
Stroke Awareness ◽  
Prior Stroke

Introduction: Rapid evaluation and treatment with rt-PA is the hallmark of acute stroke care, yet only a fraction of ischemic stroke patients arrive within the time window for treatment. National stroke awareness campaigns have attempted to increase community awareness of stroke with action plans to call 911. We sought to compare the use of emergency medical services (EMS) by stroke patients between 2005 and 2010. Methods: Stroke and TIA patients were identified in a population of 1.3 million in the Greater Cincinnati area in 2005 and 2010. Patient charts were abstracted by research nurses and reviewed by study physicians. For this analysis, patients must have resided at home and presented to a local ED. Proportion of EMS users was computed. Logistic regression was used to test for associations of EMS use with age, race, sex, prior stroke, stroke type and severity, and setting (home, work, other) where stroke occurred. Results: There were 2546 stroke cases identified in 2005 and 2704 in 2010 which met criteria for analysis. The mean age was 68 years (SD 15), 54% female, and 20% black in both study periods. EMS use did not change between study periods, 52.7% in 2005 and 52.0% in 2010 (p=.64). In both study years, increasing age, increasing stroke severity, and hemorrhagic stroke were associated with EMS use. History of prior stroke was associated with increased EMS use in 2005, but this association was not seen in 2010. Sex, race, and the setting where stroke occurred were not associated with EMS use. Discussion: Rates of EMS use in our population-based study are still only about 52% and did not increase between 2005 and 2010. Community stroke awareness campaigns should include an action plan containing the urgency of calling 911 as soon as any stroke symptoms occur.

Abstract WP274: No Improvement in Emergency Medical Services Use by Stroke Patients From 1999-2015: A Population-Based Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
James L Li ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Joseph P Broderick ◽  
Elisheva Coleman ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Population Based ◽  
Medical Services ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Stroke Disability ◽  
Stroke Type ◽  
Prior Stroke ◽  
Over Time

Objective: We sought to assess whether the proportion of stroke patients who utilized Emergency Medical Services (EMS) has changed over time in a population-based epidemiological study. Methods: Stroke and transient ischemic attack (TIA) patients were identified in a population of 1.3 million in the Cincinnati area from data in 1999, 2005, 2010, and 2015. Patient charts and EMS records were analyzed by research nurses and reviewed by study physicians. This analysis excluded strokes/TIAs that occurred while in a hospital, out of town, during EMS transport, or at unknown location. Patients with unknown EMS utilization, stroke severity, baseline pre-stroke disability, race, stroke type, or under age 18 were excluded. Proportion of EMS utilization by stroke patients was calculated and Cochran-Armitage Trend Test was used to analyze trends in EMS utilization over time. Multivariable logistic regression was used to determine the association between age, race, sex, prior stroke, stroke type, where the stroke occurred, stroke severity, and pre-stroke disability with EMS use. Results: In 1999, 2005, 2010 and 2015, 2968 of 3860, 2900 of 3643, 3010 of 3503, and 3327 of 3767 stroke cases were included, respectively. EMS use by stroke patients did not change significantly over time (52%, 51%, 52%, 53%, p=0.12 for trend). In 1999 and 2015, age, pre-stroke disability, stroke severity, hemorrhagic stroke and stroke occurring at work were significantly associated with EMS use. Race, sex, and prior stroke were not. Slight variation in associations occurred in 2005 and 2010, with stroke at work not reaching significance in 2005 and 2010, and pre-stroke disability not reaching significance in 2005. Conclusion: EMS use by stroke patients in our population did not change from 1999 to 2015. With the recent advances in treatment options for stroke, novel and effective approaches to increase EMS use are warranted.

scholarly journals Perception of stroke symptoms and utilization of emergency medical services

2016 ◽  
Vol 74 (11) ◽  
pp. 869-874 ◽  
Author(s):  
Maximiliano A. Hawkes ◽  
Mauricio F. Farez ◽  
Ismael L. Calandri ◽  
Sebastián F. Ameriso
Keyword(s):  
Emergency Medical Services ◽  
Medical Services ◽  
Stepwise Logistic Regression ◽  
Medical Providers ◽  
Stroke Patients ◽  
Arrival Times ◽  
Telephone Interviews ◽  
Emergency Medical ◽  
Stroke Awareness ◽  
Forward Stepwise

ABSTRACT Lack of stroke awareness and slow activation of emergency medical services (EMS) are frequently reported reasons for delayed arrival to the hospital. We evaluated these variables in our population. Methods Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results Seventy patients (75%) arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02). Nineteen patients (20%) were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0.001). Conclusions Our population showed a low level of stroke awareness. The use of EMS did not improve arrival times at the hospital and the non-utilization of the EMS was associated with the recognition of stroke symptoms. There was a concerning rate of misdiagnosis, mostly by non-neurologist medical providers.

scholarly journals Contacting out-of-hours primary care or emergency medical services for time-critical conditions - impact on patient outcomes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Morten Breinholt Søvsø ◽  
Morten Bondo Christensen ◽  
Bodil Hammer Bech ◽  
Helle Collatz Christensen ◽  
Erika Frischknecht Christensen ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Healthcare Services ◽  
Medical Services ◽  
Critical Conditions ◽  
Stroke Patients ◽  
Out Of Hours ◽  
Icu Stay ◽  
Emergency Medical ◽  
Time Critical ◽  
Hospital Contact

Abstract Background Out-of-hours (OOH) healthcare services in Western countries are often differentiated into out-of-hours primary healthcare services (OOH-PC) and emergency medical services (EMS). Call waiting time, triage model and intended aims differ between these services. Consequently, the care pathway and outcome could vary based on the choice of entrance to the healthcare system. We aimed to investigate patient pathways and 1- and 1–30-day mortality, intensive care unit (ICU) stay and length of hospital stay for patients with acute myocardial infarction (AMI), stroke and sepsis in relation to the OOH service that was contacted prior to the hospital contact. Methods Population-based observational cohort study during 2016 including adult patients from two Danish regions with an OOH service contact on the date of hospital contact. Patients <18 years were excluded. Data was retrieved from OOH service databases and national registries, linked by a unique personal identification number. Crude and adjusted logistic regression analyses were performed to assess mortality in relation to contacted OOH service with OOH-PC as the reference and cox regression analysis to assess risk of ICU stay. Results We included 6826 patients. AMI and stroke patients more often contacted EMS (52.1 and 54.1%), whereas sepsis patients predominately called OOH-PC (66.9%). Less than 10% (all diagnoses) of patients contacted both OOH-PC & EMS. Stroke patients with EMS or OOH-PC & EMS contacts had higher likelihood of 1- and 1–30-day mortality, in particular 1-day (EMS: OR = 5.33, 95% CI: 2.82–10.08; OOH-PC & EMS: OR = 3.09, 95% CI: 1.06–9.01). Sepsis patients with EMS or OOH-PC & EMS contacts also had higher likelihood of 1-day mortality (EMS: OR = 2.22, 95% CI: 1.40–3.51; OOH-PC & EMS: OR = 2.86, 95% CI: 1.56–5.23) and 1–30-day mortality. Risk of ICU stay was only significantly higher for stroke patients contacting EMS (EMS: HR = 2.38, 95% CI: 1.51–3.75). Stroke and sepsis patients with EMS contact had longer hospital stays. Conclusions More patients contacted OOH-PC than EMS. Sepsis and stroke patients contacting EMS solely or OOH-PC & EMS had higher likelihood of 1- and 1–30-day mortality during the subsequent hospital contact. Our results suggest that patients contacting EMS are more severely ill, however OOH-PC is still often used for time-critical conditions.

scholarly journals Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 1013-1016 ◽  
Author(s):  
Hong-Qiu Gu ◽  
Zhen-Zhen Rao ◽  
Xin Yang ◽  
Chun-Juan Wang ◽  
Xing-Quan Zhao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Emergency Medical Services ◽  
Chinese Patients ◽  
Tissue Type ◽  
Medical Services ◽  
Stroke Severity ◽  
Emergency Medical ◽  
Early Arrival ◽  
Timely Treatment ◽  
Iv Tpa

Background and Purpose— Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods— We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates’ balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment. Results— Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95–2.20] for onset-to-door time ≤2 hours, 2.32 [2.18–2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88–3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62–1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70–1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours). Conclusions— Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.

scholarly journals Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

2015 ◽  
Vol 16 (5) ◽  
pp. 743-746 ◽  
Author(s):  
Nikolay Dimitrov ◽  
William Koenig ◽  
Nichole Bosson ◽  
Sarah Song ◽  
Jeffrey Saver ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Stroke Center

Adherence to Guidelines by Emergency Medical Services During Transport of Stroke Patients Receiving Intravenous Thrombolytic Infusion

2013 ◽  
Vol 22 (7) ◽  
pp. e42-e45 ◽  
Author(s):  
Ganesh Asaithambi ◽  
Saqib A. Chaudhry ◽  
Ameer E. Hassan ◽  
Gustavo J. Rodriguez ◽  
M. Fareed K. Suri ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Adherence To Guidelines ◽  
Emergency Medical

Hospital Prenotification of Stroke Patients by Emergency Medical Services Improves Stroke Time Targets

2013 ◽  
Vol 22 (2) ◽  
pp. 113-118 ◽  
Author(s):  
James S. McKinney ◽  
Krishna Mylavarapu ◽  
Judith Lane ◽  
Virginia Roberts ◽  
Pamela Ohman-Strickland ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical

Abstract W P187: Utilization of Emergency Medical Services to Transfer Acute Stroke Patients Directly to Scanning Reduces the Length of Time to Scan Result

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Scott Dunbar ◽  
Theresa Hoffecker ◽  
Avery Schwenk
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
Emergency Medical Services ◽  
Ct Scanning ◽  
Medical Services ◽  
Time Of Arrival ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Number Of Patients ◽  
The Mean

Background: Rapid assessment and treatment of acute stroke patients including computerized tomography (CT) scanning to determine the need for tissue plasminogen activator (tPA) has been shown to be vital to positive patient outcomes. As part of an ongoing effort to reduce door-to-needle time for such patients, the door-to-CT result time was identified as an area that could be reduced by collaborative effort between Emergency Medical Services (EMS) and Emergency Department (ED) staff. We hypothesized that implementing an EMS protocol for direct-to-CT scanning as part of a collaborative stroke alert protocol would reduce overall door-to-CT result time. Methods: Local EMS and ED implemented criteria to alert the ED of acute stroke patients being transported to their facility. This alert included an estimated time of arrival and was sent to radiology, neurology, registration and pharmacy. Upon arrival, the patient was met by ED personnel while still on the EMS gurney. If the ED physician concurred with the field impression of acute stroke, the patient was taken directly to CT scanning by EMS. Data on time of door-to-CT result were collected from 7/9/12 to 7/8/13 and divided into those patients who received a stroke alert from EMS (n=41), and those who did not (n=81). All data are expressed as mean ± standard error. Results: The time for door-to-CT result was reduced (p<0.0001) for patients who received a stroke alert from EMS [16.5 ± 1.2 vs 31.6 ± 1.5 minutes, alert vs no alert, respectively]. Similarly, in the subset of patients who received tPA after the CT scan, the mean time door-to-CT scan results was reduced (p<0.005) in those patients who received a stroke alert from EMS (14.3 ± 1.1 vs 36.4 ± 7.3 minutes, alert vs no alert, respectively). Conclusions: Implementation of a stroke alert including a direct-to-CT protocol by EMS significantly reduced the mean door-to-CT result time in acute stroke patients. Expanding this protocol to include other area EMS services and hospitals could potentially result in a greater number of patients benefiting from these reduced times.

Abstract 206: Pre-notification by Emergency Medical Services is Associated with More Timely Evaluation and Treatment of Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Cheryl Lin ◽  
Eric D Peterson ◽  
Eric E Smith ◽  
Jeffrey L Saver ◽  
Li Liang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Get With The Guidelines

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent. Emergency medical services (EMS) pre-notification of stroke arrivals may provide a means of reducing evaluation and treatment times. In this study we used data from the nationwide Get With The Guidelines Stroke (GWTG-Stroke) program to determine the effect of EMS pre-notification on acute ischemic stroke processes of care. Methods: Acute ischemic stroke patients transported by EMS to 1585 GWTG-Stroke hospitals from April 2003 to March 2011 were studied. The association between EMS pre-notification and door-to-imaging (DTI) times, door-to-needle (DTN) times, onset-to-needle times (OTN), and tPA treatment rates were analyzed using multivariable GEE regression analyses. Results: Of 371,988 EMS transported acute ischemic stroke patients, EMS pre-notification occurred in 249,197 (67.0%). Patients with pre-notification had shorter door-to-imaging times, shorter onset-to-needle times, and were more likely to be treated with tPA when eligible ( Table ). EMS pre-notification was independently associated with increased odds of DTI ≤25 minutes (adjusted OR 1.53, 95% CI 1.44–1.63, p<0.0001), DTN times ≤60 minutes (aOR 1.20, 95% CI 1.10–1.31, p<0.0001), OTN times (aOR 1.17, 95% CI 1.09–1.25, p<0.0001), and tPA use within 3 hours among eligible patients arriving by 2 hours (aOR 1.64, 95% CI 1.50–1.79, p<0.0001), without significant increases in complications of thrombolytic therapy. Conclusion: EMS pre-notification is independently associated with more rapid patient imaging and increased timeliness in IV tPA administration. These results support the need for initiatives targeted at increasing EMS pre-notification rates as a mechanism from improving quality of care and outcomes in acute ischemic stroke.

scholarly journals Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sudha Xirasagar ◽  
Meng-han Tsai ◽  
Khosrow Heidari ◽  
James W. Hardin ◽  
Yuqi Wu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
The United States ◽  
Medical Services ◽  
Stroke Severity ◽  
Convenience Sample ◽  
Post Stroke ◽  
Emergency Medical ◽  
Stroke Disability

Abstract Background Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. Methods During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. Results Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. Conclusion Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.

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